How Strong Are Your Pelvic Floor Muscles?

Andrew Siegel MD  9/9/17

Note: Although the image below is that of a woman who has likely has a strong pelvic floor, this entry is equally relevant for both women and men. 


Attribution of above image: By Mr. Yoga ( [CC BY-SA 4.0 (, via Wikimedia Commons


The Pelvic Floor Muscles in Men and Women (really not so different)


Attribution of above image: By OpenStax [CC BY 4.0 (, via Wikimedia Commons

A Few Questions & Answers About the PFM

Q. Why should you give a hoot about your PFM?                               

A. PFM integrity, strength and endurance are vital for optimal sexual, urinary, and bowel function in both females and males. If you don’t think bladder/intestinal control, pelvic organ support or sex is important, don’t bother to read on!

Q. Why do your PFM weaken?                                                                                  

A. The PFM lose strength with aging, obesity and not using them (disuse atrophy).  Their integrity is deeply impacted by pregnancy, labor and delivery in females and pelvic surgery (radical prostatectomy, colon/rectum operations, etc.) in males.

Q.  How can your PFM be strengthened?                                                                        

A. Like any skeletal muscles, the PFM can be strengthened through targeted exercise.

Q. What are important parameters of PFM function?

A. Strength at rest and with actively contracting the PFM; ability to voluntarily relax the PFM; endurance (ability to sustain a PFM contraction before fatigue sets in); and repeatability (the number of times a PFM contraction can be performed before fatigue sets in).

Q.  How is PFM strength tested?  

A. There are many ways to assess PFM strength.  Some clues as to female PFM strength are a snug and firm vagina with no urinary control issues, dropped pelvic organs or sexual problems. Some clues as to male PFM strength are good quality erections and ejaculation and no dribbling of urine after completing urinating. The ability to briskly lift up the erect penis (while in the standing position) when contracting the PFM is a sign of PFM strength. 

Other means of assessing PFM strength are the following:

1. Visual Inspection: Observe the perineum (area between anus and scrotum/vagina) prior to and during the PFM contraction.  The perineum should lift upwards and inwards and the anus should contract (anal wink). 

2. Vaginal (or Anal) Palpation: Place a finger in the vagina or anus, contract the PFM and subjective judge PFM strength using the Oxford scale (0-5). 0: no contraction; 1: flicker; 2: weak; 3: moderate;  4: good; 5: strong 

3. Perineometry: A pressure-measuring probe is placed in the vagina or rectum.  The device registers the squeeze pressure on the probe during a PFM contraction.

4. Electromyography: Patch electrodes (that resemble EKG electrodes) are placed on the  perineum. A recording of electrical activity generated by PFM contractions is made.

5. Dynamometry: A cylindrical steel tube that measures compressive strength is placed in the vagina or rectum. The device registers the squeeze pressure on the load cell built into the steel tube.

6. Ultrasound: Sound wave technology images the perineum and PFM during an active contraction.

Bottom Line:  Unlike the external, mirror-appealing muscles, the PFM are humble muscles that are shrouded in secrecy,  unseen and behind the scenes and often unrecognized and misunderstood. Their mysterious powers straddle the gamut of being vital for what may be considered the most pleasurable and sublime of human pursuits—sex—but equally integral to what may be considered the least refined of human activities—bowel and bladder function. Because they are out of sight and out of mind, they are often neglected. However, there is great merit in exercising important hidden muscles, including the heart, diaphragm and PFM. Although they are not the muscles of “glamour,” the PFM are the muscles of “amour” and merit the respect that is accorded the external glamour muscles of the body. 

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in dire need of bridging.

For more information on the pelvic floor muscles and how to properly condition them, please consult the following books by the author:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

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